People-Centered Leadership, Organizational Commitment and Retention in Public Healthcare: A Governance-Sensitive Integrative Model

Background: Public healthcare systems face persistent workforce retention challenges that undermine service continuity, organizational resilience, and public value creation. Although leadership is frequently identified as a relevant lever, the literature remains theoretically fragmented and often treats leadership effects as direct and context-free. Methods: This review adopts a PRISMA-guided systematic literature review as a theory-building strategy. Searches were conducted in Web of Science, Scopus, and PubMed using combinations of terms related to leadership, organizational commitment, job satisfaction, turnover intention, and retention in healthcare settings. The review identified 640 records, removed 372 duplicates, screened 268 titles and abstracts, assessed 90 full-text records for eligibility, and retained 30 peer-reviewed studies for configurative synthesis. The analysis combined thematic synthesis with configurative mapping to identify mechanisms, recurring patterns, and contextual contingencies. Results: The review shows three consistent patterns. First, leadership is linked to retention predominantly through organizational commitment, especially affective and normative commitment, rather than through direct effects. Second, institutional and organizational conditions—particularly red tape and working conditions—shape the strength of leadership–commitment relationships. Third, workforce heterogeneity, including generational differences, affects how leadership practices and organizational environments are interpreted, although these dynamics are rarely theorized explicitly in the literature. Conclusions: The article develops a governance-sensitive integrative framework in which people-centered leadership influences turnover intentions indirectly through organizational commitment, while red tape and working conditions operate as contextual moderators. By embedding leadership within Public Administration and governance theory, the review clarifies the literature’s main explanatory gap and provides a foundation for comparative empirical testing and for more sustainable workforce strategies in public healthcare systems.